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Biomedical subjects

A R Dimick

Publications and source records attributed to A R Dimick.

50 records · Page 3Linked to original sources
PubMedDate not supplied

Effects of auricular acupuncture-like transcutaneous electric nerve stimulation on pain levels following wound care in patients with burns: a pilot study.

This study was designed to test the hypothesis that auricular acupuncture-like transcutaneous electrical nerve stimulation would significantly reduce the pain experienced by patients with burns immediately after wound debridement, other wound care, and dressing changes. Subjects were 11 inpatients at the University of Alabama Hospital Burn Unit. A two-period crossover design was used, and each patient received one experimental treatment consisting of bilateral acupuncture-like transcutaneous electrical nerve stimulation to six ear points and one control treatment consisting of a placebo pill. The Visual Analogue Scale was used as a measure of pain and was completed immediately before and after treatments and at 15, 30, and 60 minutes after treatment. A two-factor repeated measures ANOVA indicated significant effects of measurement time (p less than 0.001) and treatment by time (p = 0.002). Post hoc analysis revealed significant differences (p less than 0.05) between experimental and control conditions at all times after treatment but not at pretreatment baseline. These results indicate that auricular acupuncture-like transcutaneous electrical nerve stimulation may be an effective pain management technique in patients with burns.

Bandages↗
PubMedDate not supplied

Methods to diminish intraoperative blood loss.

With the subcutaneous injection of a saline-vasopressor solution under donor sites and debrided areas, a significant reduction in intraoperative blood transfusions was accomplished. No problems in healing of donor sites or skin grafts were encountered. Vasodilating anesthetics and ketamine can overcome the local vasopressor action. Discontinuing or reducing the concentration of these agents results in less bleeding from the wound.

Blood Loss, Surgical↗
PubMedDate not supplied

Classifying patients with burns for hospital reimbursement: diagnosis-related groups and modifications for severity.

This study was designed to evaluate the relative severity and resource consumption of hospitalized patients with burns in a national cross section of hospitals, both with and without burn centers. We investigated to determine whether clinical variables or severity of illness measures not recorded in the Uniform Hospital Discharge Data Set are significant in explaining variation in length of stay, total cost, and mortality for patients with burns. The ability of the six burn diagnosis-related groups (DRGs) to explain variation in patients' length of stay was 20% and their ability to predict total costs was 24%. For the same patient population, the explanatory power of the DRGs improved to 54% for length of stay and 44% for costs when these variables were adjusted by the Severity of Illness Index. We also investigated whether hospitals with burn centers treated a more severely ill population of patients with burns than did hospitals without such centers. Significantly higher levels of severely ill patients with burns (p less than or equal to 0.0001) were found at burn center hospitals. Other patients or treatment variables, combined with a case-mix severity measure, were evaluated for their ability to further increase the explanatory power of DRGs. We also discuss here the use of the study results for reevaluating reimbursement policy.

Burn Units↗
PubMedDate not supplied

A biopsy of the use of the Baxter formula to resuscitate burns or do we do it like Charlie did it?

The Baxter formula is commonly used to calculate fluid requirements. Baxter reported that 12% of patients would require more than 4.3 mL/kg per percentage of total body surface area (%TBSA). We anecdotally observed that we frequently exceeded the predictions of the formula, and we wondered if this was unique to our practice. We studied our last 11 burn-related resuscitations and collected fluid resuscitation data from US burn centers. Twenty-eight centers were queried, and 6 centers shared data. We were therefore able to study the resuscitation data of 50 adult patients. For 29 patients (58%), 4.3 mL/kg/%TBSA was exceeded compared with the 12% reported by Baxter. These findings suggest that in actual practice, fluid volumes administered are larger than the Baxter formula predicts. This survey does not explain why. Possible reasons for the larger fluid volumes are as follows: (1) the sample is not representative; (2) the formula is used improperly; (3) burns have changed and require more fluids; (4) burn care has changed.

Adult↗
PubMedDate not supplied

The trauma table as an alternative to the Hubbard tank in burn care.

Because of disadvantages associated with the use of the Hubbard tank in the management of burn patients, the burn team at the University of Alabama replaced the tank with a trauma table that had been manufactured to their specifications. The trauma table is capable of being hydraulically raised or lowered, and maneuvered into Trendelenburg's position or its reverse. Another feature of the table is side rails that can be lowered. In contrast to the Hubbard tank, the trauma table has the following associated advantages: (1) quicker treatment sessions; (2) less pain to the patient; (3) elimination of patient exposure to contaminated water; (4) more comfort for the therapist; and (5) greater ease in patient handling, for example, rolling the patient onto a stretcher or bringing the patient into a sitting position.

Burn Units↗
PubMedDate not supplied

A physiologic analysis of cardiopulmonary responses to ketamine anesthesia in noncardiac patients.

In 16 adult patients, IV ketamine, 2.2 mg/kg body weight, did not produce dramatic effects on left heart function or systemic circulation. Minute O2 consumption and O2 delivery were stable. An appreciable elevation in pulmonary vascular resistance occurred which secondarily increased right heart work. Total intrapulmonary shunt initially increased; however, the effect was short lived and did not cause clinical alterations in PaO2. The authors conclude that physiologic alterations associated with ketamine are more pronounced on the pulmonary than on the systemic vascular bed, and to the right rather than to the left side of the heart.

Adult↗
PubMedDate not supplied

The development of burn centers in North America.

Burn center development in North America began in the mid 1940s, surged in the 1970s, and had reached virtually every distinct medical market by 1985. The authors present chronologies of the establishment of 137 currently active burn centers in the United States and 27 burn facilities in Canada, discuss public policy and other influences on burn center development, and review burn admissions trends. Another 46 U.S. hospitals are identified as having shown interest in caring for serious burn injuries in recent decades. Since national admissions data first became available in 1970, the proportion of U.S. patients with burns treated in burn centers has increased from 10% to 40%. Data were obtained from a survey of 197 hospitals in the United States and Canada listed in recent Burn Care Resources directories of the American Burn Association and annual surveys of the American Burn Association and the National Center for Health Statistics. Further study of burn centers in both institutional and societal contexts and submittal of archival material are encouraged.

Burn Units↗